Middleton Brewing 12/28/2020 - Laserfiche WebLink

� Acc Rt$ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/pp1YYYY) ,---- 12/14/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Stacy Butler Butler Insurance Services,Inc. PHC No.Ex0: 208-321-0081 i riot,No): 208-321-0082 9504 Fairview Avenue SS: Stacy@butlerirtsuranceservices.com INSURER(S)AFFORDING COVERAGE NAIC# Boise ID 83704 INSURER A: Depositors Insurance Company 42587 INSURED------------ INSURER 8: GEOFFREY MIDDLETON INSURER C: DBA: Middleton Brewing INSURER D: 607 SE Everett Mall Way Ste 27 INSURER E:TM Everett WA 98208-3264 INSURER F: —_._.-------__._--COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRF ADM S-U-SR ' POLICY EFF 1 POLICY EXP i LTR TYPE OF INSURANCE 1 INSO i WVD j POLICY NUMBER (MMM1DD(YYYY)+(MM!DDFYYYY)', LIMITS COMMERCIAL GENERAL LIABILITY t ' f EACH OCCURRENCE 1$ 1,000,000 CLAIMS-MADE X [-DAMAGE-TO To RENTED 3 ." J OCCUR I,.F'REIISESJEa,occurrence) _$ { ; MED EXP(Any one person) $ 5,000 A X ACP BPFD 3057300360 08/08/2020 0B/01/2021 1 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 _X POLICY JE C I LOC 1 PRODUCTS-COMP/OP AGG $ 2,000.000 OTHER: __ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ .re.a accident) ANY AUTO BODILY INJURY(Per person) $ __ _'OWNED _____ SCHEDULED i ,-�__ i AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY — AUTOS ONLY (Per accident_ $ $ UMBRELLA LIAR ;OCCUR EACH OCCURRENCE $ EXCESS UAB ( CLAIMS-MADE I AGGREGATE $ _ DEL) I I RETENTION$ $ WORKERS COMPENSATION 1 PER OTH- STATUTE.. IER AND EMPLOYERS'LIABILITY Y i N RJ ANYPROPRIETOR/PARTNEEXECUTIVE N i A �mE_L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) , E.L.DISEASE-EA EMPLOYEE $ If yes,describe under --.__..-----._.—--.- DESCRIPTION OF OPERATIONS below 1 EL DISEASE-POLICY LIMIT $ 4 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THE CITY OF EVERETT IS LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION CITY OF EVERETT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore Avenue Everett WA 98201 AUTHORIZED REPRESENTATIVE Stacy S Butler i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD